The term "Sensory" has hit schools and hit them big. Many school districts are building their own motor labs complete with swings, trampolines, and squeeze machines (I can't recall the technical term for these, but that is essentially what it is). School administrators are promoting these rooms to teachers and parents, with occupational therapy being highly recognized in the promotion of "sensory" within the school setting.
Yet I have felt there has been something lacking in the implementation of sensory tools and rooms that would justify pulling students from their educational curriculum to participate in "sensory" activities. I have noticed little connection between the use of these rooms and tools to research sensory integration theory.
Students with excellent gross motor skills leave their academics in order to come to the motor lab and receive "input to organize their sensory processing", yet the people bringing them there have very little, if any, background in occupational therapy or sensory integration theory. I don't believe that the needs of students should be neglected; however, I do think it would be wise to pause and consider what school is for and how we can truly support our students with sensory processing difficulties in their educational needs. Sensory integration and sensory-based strategies were never intended to be a "one-size fits all model". Like occupational therapy itself, sensory integration is designed to be highly individualized to the child, environment, and occupational performance.
I have to admit I have never been a big fan of sensory integration in school-based practice. I have found that implementing proper sensory integration-based strategies, evaluation, and therapy is difficult due to my limited schedule and skill set. Evaluating how children process and integrate sensations from their environment is complex and requires specialized knowledge and training.
When evaluating sensory processing within the school-based setting, it is important for the occupational therapist to consider more than what tool could be trialed. Assessment should also include how sensory processing difficulty is impacting functional performance beyond the apparent "sensory-related behavior." When addressing sensory, the school-based practitioner may want to ask two more questions should include: What are the demands of the classroom environment? How will the child meet the needs of given classroom activities? If the student is fidgeting frequently, it is important also to observe how this impacts his classroom performance and his ability to meet classroom demands. This will affect what strategies you utilize and how you go about implementing them. It is not enough to merely provide a tool based on this observed behavior, as that could be counterproductive or ineffective.
Giving the Sensory Processing Measure or Sensory Profile can provide important information; however, it is also essential to conduct classroom observations and other clinical observations of the child to truly determine what approach will be practical. Staff interviews and having classroom personnel collect data on the observable sensory-related behaviors are also necessary and can help the occupational therapist best fit their approach by considering the needs of the classroom in conjunction with the child's needs.
I recognized my limitations in regard to sensory integration when I recently fell into the "easy button" sensory tool approach myself. I provided a student who had a diagnosis of autism with a "chew tool" due to his teacher-reported sensory needs and history of having had this particular strategy used in the past with reported success. Without having conducted an observation or worked with him directly, I caved to the pressure of providing the tool on a trial basis. The student chewed so extensively that he went through three of them quickly with little change in his maladaptive behaviors (i.e., his grabbing and pulling hair, pinching staff, and squeezing faces). I should note that he had access to various sensory-based tools, including a therapy ball, headphones, a weighted vest, thera-band, and multiple squeezable fidgets. I decided that before providing the 4th "chew tool," I would conduct classroom observations to determine what was impacting his classroom performance and better understand how his sensory processing was preventing him from meeting the demands of his environment and expected task performance.
Once I put on my occupational therapy hat and observed the student in his classroom, a series of "Aha" moments began to occur to me! The first thing I decided to do was build a profile of the student. He was a student with Autism who demonstrated behaviors related to a very high excitement level. I would even say his behaviors appeared anxious and ones of discomfort (he was observed to grimace and squint frequently). He seemed highly sensitive to every bit of stimuli in his environment. He also demonstrated significant difficulty communicating his needs. Communication appeared to be slow and in short phrases and words. This student also seemed to scan the room by moving his entire head and body versus utilizing scanning and tracking skills.
The second part of classroom observation included observing during non-preferred activities during which his maladaptive behavior was more likely to occur. I then observed two separate moments when the maladaptive behavior occurred. Both happened during the reading and writing center on two different observations. Before both behavior incidents, another student had acted out by falling onto the floor and yelling at the same center. It should also be noted that I had reviewed his previous assessments, and reading and writing a largely non-preferred tasks for this student, as well as his most significant area of deficit.
The third part of the evaluation was how the student coped or attempted to cope with the environment and task demands, given his sensory processing difficulties. Before the behavior incident, the student tried to move away from his acting-out classmate, and the teacher had prevented him from leaving. She required that he first tell her what he wanted before he was allowed to get up and access his headphones. Being that he was already distressed, he was not able to communicate this and eventually grabbed her hair and face. In observing these moments, it became more apparent that a "chew tool" would not be the answer.
What the teacher had told me was sensory-based due to the lack of tools (i.e., she wanted a trampoline in her classroom and more chew tools) was, in fact sensory based; however, it would not have been made better with the use of those tools. I also discovered after interviewing staff that this student had been moved from his previous year's class into his current placement. This classroom had new staff, teachers, peers, and higher demands and was within a very different environmental structure with less freedom or free time than he had been used to.
To top it off, he had been in his previous class for three years. The teacher and aids knew how to anticipate his needs and scaffold his environment to prevent these behaviors; therefore, his behaviors and previous sensory seeking had nearly disappeared before this change. Given this student's high sensory sensitivity, he required more support to reduce sensory input during challenging tasks, incorporating more sensory breaks where he could escape or reduce the sensory information he was receiving, as well as highly structuring his classroom tasks experiences. Based on my observations and interviews, we were able to collaboratively come up with a plan to address this student's needs.
Conducting these observations is imperative to appropriately utilizing the models in sensory integration, and it can be difficult to perform these observations and interviews adequately, but I would argue that it is also necessary to provide sensory integration-based strategies within the classroom setting. Luckily, I work in a school district that is interested in keeping our caseloads manageable so that I have the time to perform these essential job duties. I have worked in other districts where I was fighting just to stay afloat, so observations such as these were not easily conducted. It is easy to become complacent or so overwhelmed that we end up offering sensory-based tools as easy buttons. Still, we need to remember that this is not sensory integration, and often, it is also not evidence-based.
I'm not trying to downplay the power of fidgets or wiggle seats, and I'm definitely not advocating for removing these tools. Still, as occupational therapists working in schools, I am encouraging us to remember that sensory integration theory differs from the tools. Our job as the occupational therapist is to assess the student's needs and how that impacts classroom performance.
When we look to simplify sensory into a tool or strategy, it can lead to a broader misunderstanding and misinterpretation of sensory integration. Like sensory integration itself, occupational therapy is difficult to describe and, by its very nature, complex in its evaluation and implementation. I say we embrace this complexity in both occupational therapy and sensory. We need to advocate for sensory integration in schools by embracing and teaching the complex nature of both sensory integration and school-based occupational therapy to the school personnel, parents, and administrators of the schools we service.
What are you doing to promote the appropriate use of sensory integration-based tools within the classroom? Do you feel you have adequate knowledge and skills to tackle student needs in this area? What would you like more training in?
For more reading on the use of sensory integration in school settings, check out the links to references below:
Thank you for reading! When we all work together, we can promote occupational therapy in schools and our communities! :)
Abby
